الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Cardiovascular diseases, in particular coronary artery disease (CAD), remain a leading cause of morbidity and mortality in most regions worldwide.
Acute coronary syndromes also have a significant economic impact through direct health care costs and productivity losses.
Patients with ACS usually have many concomitant diseases, handled by a variety of providers and hence, taking multiple drugs. This situation is a ‘‘perfect storm’ that predisposes patients to hence inadequate drugs adherence.
Pharmacists are ideal members of the healthcare team to optimize drug therapy, adjust drug doses, address communication gaps between patients and providers, monitor laboratory results, simplify the regimen and find lower-cost alternative medications where appropriate.
Pharmacists can also educate post ACS patients about the disease state, including risk factors, complications, signs and symptoms of anginal attack; safe and appropriate use of medications; the post discharge plan for follow-up; therapeutic interventions aimed at controlling modifiable risk factors for ACS; and lifestyle modifications.
Therefore, the aim of this study was to investigate the role of clinical pharmacist on the outcome of post ACS patients in cardiac rehabilitation unit.
The current study was a prospective, block randomization-controlled study to be carried out on post-acute coronary syndrome (ACS) patients for 3 months at cardiac rehabilitation unit, Department of Cardiology, Ain Shams University Hospitals, Cairo, Egypt.
The study was conducted on 40 post ACS patients, patients were randomized into 2 groups:
Control group (CG): Twenty patients received the usual or the standard medical care by the cardiologist only which include physical examination, prescribing medications and adjust doses of cardiovascular drugs when needed
Intervention (IG): Twenty patients received the pharmaceutical care by the clinical pharmacist in collaboration with the cardiologist who provides the usual medical care.
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SUMMARY
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At baseline, all patients were subjected to the following:
• Patients’ data collection (age, gender, body mass index [BMI], diagnosis, waist circumference, duration of CHD, Risk Factors, Past and Concurrent diseases, Past and Concurrent medications)
• Clinical examination.
• Laboratory evaluation.
• Transthoracic echocardiographic data.
• Assessment of quality of life
• Assessment of medications adherence
• assessment of smoker’s dependence on cigarette smoking
• Dietary evaluation
Pharmaceutical care services provided by clinical pharmacist for the intervention group included:
▪ Review of the patients’ drug therapies.
▪ Assessment of each patient’s drug related problems (for both groups by the clinical pharmacist).
▪ systematic search to identify the best available evidence to solve medication-related problems or to help identify other problems.
▪ Suggestion of solutions for these problems to increase the patient compliance, only in the intervention group. All the solutions of drug related problems were discussed with the physician in attendance to approve them.
▪ Education sessions which were limited to 30-35 min each session provided only to the intervention group patients
▪ Providing a written educational material including all the above data for each patient in the intervention group.
The patients of the two groups were followed-up every two weeks for the duration of the study.
At the end of the study, all of the above data were collected again to assess the effect of clinical pharmacist on patients’ outcome.
SUMMARY
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After 3 months of study implementation, a significant difference between the 2 groups (control vs. intervention) was found in;
• patients’ adherence to medications.
• patients’ knowledge of their CV disease and drugs.
• quality of life
• echocardiographic parameters.
• drug related problems.
• laboratory parameters.
In conclusion, a comprehensive approach by healthcare providers, including pharmacists, may have a positive impact on the individual components of cardiovascular risk factors, medication adherence, drug related problems and patients’ knowledge about their disease and drugs.
It is recommended to conduct more extensive and multi-centric clinical trials to better demonstrate the impact of clinical pharmacist on the clinical outcome in ACS patients.